The objective of this application is to support and foster the career development of Dr. Peter Cram in becoming an outstanding clinician-scientist and independent researcher. For this application, Dr. Cram has assembled a team of experienced mentors, Drs. Janet Schlecte (primary Mentor), Alan Christensen (Co-mentor), and Robert Wallace (Co-Mentor) to insure his successful development. Dr. Cram's research will focus on the barriers to treatment of patients with osteoporosis. In order to accomplish his goals, Dr. Cram will immerse himself in rigorous study through focused tutorials and readings guided by his mentors. He will also complete targeted coursework in areas of biostatistics and survey research, health psychology and ethical conduct of research. In addition, under the guidance of Dr. Schlechte, he will gain expertise in the clinical management of patients with osteoporosis. During the funding period, the candidate will conduct three sequential and incremental projects at three different study sites that examine barriers to treatment among patients who are identified as having osteoporosis on screening dual energy x-ray absorbtiometry (DXA) scan. Project 1 will involve a detailed medical record review to identify patient and physician-specific factors associated with undertreatment of patients diagnosed with osteoporosis after screening DXA scans. Project 2 (beginning in month 18) will examine patient preferences for notification of their results and socio-demographic and psychological traits. Project 3 (beginning in month 48) will be based upon the results of Projects 1 and 2. This randomized trial assess a patient activation intervention, consisting of mailing patients the results of their DXA scans along with education material about the interpretation of their results, can improve the treatment of osteoporosis and patient satisfaction. Finally, this work will serve as a model for examining the barriers to and improving treatment of other chronic diseases identified through screening.